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Title Last updatedsort ascending Attachments
Form L-TEMP: Application for a Temporary Insurance License 01/08/2018 (Fri)
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PDF icon l-temp_20180618.pdf63.23 KB
Form E-820: Service Company Application Checklist 11/08/2018 (Tue)
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PDF icon Form E-820 Service Company Review Checklist817.73 KB
Form E-811: Renewal of Service Company Permit 09/08/2018 (Tue)
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PDF icon Form E-811 Service Company Renawal952.57 KB
Form E-800: Application for Service Company Permit 09/08/2018 (Tue)
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PDF icon Form E-800 Service Company Application1017.23 KB
Form E-CR-C: Uniform Application Checklist for Certified Reinsurers 09/07/2018 (Fri)
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PDF icon Certified Reinsurer E-CR-C Application Checklist.pdf1.24 MB
Form ER002: Registration Application 09/07/2018 (Fri)
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PDF icon Foreign Risk Retention Group Registration Application E-R002.pdf659.3 KB
Form ER001: Filing Instructions 09/07/2018 (Fri)
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PDF icon Foreign Risk Retention Group Filing instructions E-R001.pdf58.69 KB
Form E185F: Instructions for the completion of the Enterprise Risk Report 09/07/2018 (Fri)
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PDF icon Holding Company Form F E-185F.pdf57.92 KB
Form E185B: Instructions for the Completion of the Form B Registration Statement 09/07/2018 (Fri)
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PDF icon Holding Company Form B E-185B.pdf69.47 KB
Form E185: Outline for Compliance with Insurance Holding Company Systems Reporting Requirements 09/07/2018 (Fri)
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PDF icon Holding Company Instructions E-185.pdf62.88 KB
Form E-CR-1: Certificate of Certified Reinsurer 08/07/2018 (Thu)
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PDF icon Certified Reinsurer E-CR-1 Certificate.pdf1.84 MB
Form E-AR-1: Certificate of Assuming Insurer 08/07/2018 (Thu)
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PDF icon Reinsurer E-AR-1 Certificate of Assuming Insurer.pdf1.49 MB
Form E-654: Application for Life Care Provider Permit Change 08/07/2018 (Thu)
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PDF icon Life Care Provider Permit Change E-654.pdf646.21 KB
Form E-652: Application for Life Care Provider Permit 08/07/2018 (Thu)
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PDF icon Life Care Provider Permit Application E-652.pdf673.06 KB
Form ER002: Registration 08/07/2018 (Thu)
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PDF icon Foreign Risk Retention Group Registration Application E-R002.pdf659.3 KB
FORM ER001 FOREIGN RISK RETENTION GROUP FILING INSTRUCTIONS 08/07/2018 (Thu)
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PDF icon Foreign Risk Retention Group Filing instructions E-R001.pdf58.69 KB
Form E-SR.AFR: Sr. Residential Entrance Fee Contracts: Provider Annual Audited Financial Report Transmittal Form 08/07/2018 (Thu)
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PDF icon Sr. Residential Entrance Fee Contract Provider Annual AFR Transmittal E-SR.AFR_.pdf159.17 KB
Form E-SR.INSTR: Sr. Residential Entrance Fee Contracts: Provider Compliance With A.R.S. Title 44, Chapter 25, Article 1 08/07/2018 (Thu)
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PDF icon Sr. Residential Entrance Fee Contract Provider E-SR.INSTR_.pdf54.07 KB
Form E-LSPF: Life Settlement Provider Anti-fraud Plan Checklist 08/07/2018 (Thu)
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PDF icon Life Settlement Provider E-LSPF.pdf584.2 KB
Form E-LSPS: Life Settlement Provider Annual Statement 08/07/2018 (Thu)
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PDF icon Life Settlement Provider Annual Statement E-LSPS.pdf1.36 MB
Form E-LSP4: Life Settlement Provider Statutory Agent Appointment and Acceptance 08/07/2018 (Thu)
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PDF icon Life Settlement Provider E-LSP4.pdf112.27 KB
Form E-LSP2: Life Settlement Provider Report of Stockholders/Owners 08/07/2018 (Thu)
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PDF icon Life Settlement Provider E-LSP2.pdf98.87 KB
Form E-LSP1: Life Settlement Provider Application for Certificate of Authority 08/07/2018 (Thu)
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PDF icon Life Settlement Provider E-LSP1.pdf98.9 KB
Form E-LSPI: Life Settlement Provider Application for Certificate of Authority - Instructions 08/07/2018 (Thu)
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PDF icon Life Settlement Provider E-LSPI.pdf160.25 KB
Form E-LSP3: Life Settlement Provider Report of Officers, Directors, Members, Partners and Designated Employees 08/07/2018 (Thu)
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PDF icon Life Settlement Provider E-LSP3.pdf98.12 KB
Form E184: Instructions for the Completion of the Form A Statement Regarding the Acquisition of Control of, or Merger with, a Domestic Insurer 08/07/2018 (Thu)
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PDF icon Holding Company Form A E-184.pdf70.45 KB
Form E185E: Instructions for the Completion of the Pre-acquisition Notification Form 08/07/2018 (Thu)
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PDF icon Holding Company Form E E-185E.pdf56.32 KB
Form E185F: Instructions for the Completion of the Enterprise Risk Report 08/07/2018 (Thu)
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PDF icon Holding Company Form F E-185F.pdf57.92 KB
FORM E-DIRCOMWAIVER: Arizona Domestic Insurers Board of Directors and/or Committees Waiver Application 08/07/2018 (Thu)
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PDF icon Holding Company Directors Committees Waiver E-DIRCOMWAIVER.pdf58.58 KB
Form E185D: Instructions for the Completion of the Form D Prior Notice of a Transaction Pursuant to A.R.S. § 20-481.12 07/07/2018 (Thu)
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PDF icon Holding Company Form D E-185D.pdf64.49 KB
Form E185XD: Instructions for Approval of Extraordinary Dividends and Other Distributions 07/07/2018 (Thu)
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PDF icon Holding Company Extraordinary Dividends E-185XD.pdf54.25 KB
Form E185CHC: Instructions for a Change to Form C Summary of Registration Statement 07/07/2018 (Thu)
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PDF icon Holding Company Form C Change E-185CHC.pdf54.96 KB
Form E185CHB: Instructions for a Change to Form B Registration Statement 07/07/2018 (Thu)
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PDF icon Holding Company Form B Change E-185CHB.pdf54.79 KB
Form E185C: Instructions for the Completion of the Form C Summary of Registration Statement 07/07/2018 (Thu)
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PDF icon Holding Company Form C E-185C.pdf55.92 KB
Form E-CERTREQ: Certificate Request Form 10/07/2018 (Tue)
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PDF icon Certificate Request Form964.81 KB
Form C-RFI 03/07/2018 (Mon)
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PDF icon form_c-rfi.pdf850.66 KB

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Warning - Phishing Scam

We are aware of a phishing scam targeting insurance professionals claiming that the National Association of Insurance Commissioners received a complaint that the professional submitted a falsified claim. This fraudulent email displays the NAIC and CIPR logos, can originate from what appears to be an naic.org or gmail.com email account, and instructs the recipient to click on a link to download the complaint notification.

Certain antivirus products will detect this as a malicious email.  If you receive a similar email and have any concerns, contact the NAIC Service Desk at (816) 783-8500 or [email protected].